title: Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review.
abstract: BACKGROUND
  Psychiatric disorders occur in approximately 90% of individuals dying by suicide. The prevalence of psychiatric disorders in people who engage in non-fatal self-harm has received less attention.
  
  
  METHODS
  Systematic review using electronic databases (Embase, PsychINFO and Medline) for English language publications of studies in which psychiatric disorders have been assessed using research or clinical diagnostic schedules in self-harm patients of all ages presenting to general hospitals, followed by meta-analyses using random effects methods.
  
  
  RESULTS
  A total of 50 studies from 24 countries were identified. Psychiatric (Axis I) disorders were identified in 83.9% (95% CI 74.7-91.3%) of adults and 81.2% (95% CI 60.9-95.5%) of adolescents and young persons. The most frequent disorders were depression, anxiety and alcohol misuse, and additionally attention deficit hyperactivity disorder (ADHD) and conduct disorder in younger patients. Personality (Axis II) disorders were found in 27.5% (95% CI 17.6-38.7%) of adult patients. Psychiatric disorders were somewhat more common in patients in Western (89.6%, 95% CI 83.0-94.7%) than non-Western countries (70.6%, 95% CI 50.1-87.6%).
  
  
  CONCLUSIONS
  Heterogeneity between study results was generally high. There were differences between studies in identification of study participants and diagnostic procedures.
  
  
  CONCLUSIONS
  Most self-harm patients have psychiatric disorders, as found in people dying by suicide. Depression and anxiety disorders are particularly common, together with ADHD and conduct disorder in adolescents. Psychosocial assessment and aftercare of self-harm patients should include careful screening for such disorders and appropriate therapeutic interventions. Longitudinal studies of the progress of these disorders are required.
authors.affiliation: Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital Oxford, Oxfordshire, United Kingdom. Electronic address: keith.hawton@psych.ox.ac.uk.
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.forename: Kate
authors.initials: K
authors.lastname: Saunders
authors.forename: Anya
authors.initials: A
authors.lastname: Topiwala
authors.forename: Camilla
authors.initials: C
authors.lastname: Haw
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001008:Anxiety Disorders / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology; D016728:Self-Injurious Behavior / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology; D055815:Young Adult
keywords: Attempted suicide; Personality disorders; Psychiatric disorders; Self-harm; Systematic review